Prostate Cancer

• Introduction

The word cancer is always associated with a great panic in the world because this disease has taken from us many of our friends and family members. Prostate cancer has different characteristics as other more aggressive cancers affecting other organs. It is a condition that develops slowly and it is common that an old man may die of other causes rather than prostate cancer.

It is rare in younger ages but increases progressively with age. It is significant that 30% of men over the age of 50 years are likely to have prostate cancer and therefore it is very likely a man around 70 to 80 years of may have prostate cancer, but not ultimately die due to it.

• Prognosis

Prostate cancer is the most common malignancy of the urinary system and is the third cause of cancer death in men. The estimated latent risk for prostate cancer during the life of a man in the age of 50 is 40% but clinically it is found only in 9.5% while only 2.9% of the men will result in death. Therefore, prostate cancer is a slowly progressive condition that probably does not create life-threatening events if diagnosed early and treated appropriately. It should be noted that the probability of developing prostate cancer increases with age. Moreover, men who have within the immediate family people who had prostate cancer are more likely to have prostate cancer themselves.

• Symptoms, Diagnosis

The symptoms that bring the patient to a physician is similar to the enlargement of the prostate (benign prostatic hyperplasia). Most cases of prostate cancer are diagnosed at an early stage. Incidental findings after transurethral prostatectomy for simple enlargement of prostate may also result in diagnosis of prostate cancer. The final diagnosis and differentiation of this situation from the simple enlargement of the prostate is done by the following means:
⇒  Digital rectal examination of prostate.
⇒  Prostate specific antigen (PSA).
⇒  Prostate Ultrasound.
⇒  Prostate Biopsy.
The urologist performs a digital rectal examination and estimates the prostate by palpation with the fingertip. It is the oldest method, but still a reliable method to initiate investigation of a prostate gland with possible cancer. A prostate that contains cancer is hard to the touch and loses its normal shape. PSA testing is the next diagnostic step. PSA is a substance found in the blood, which gives good information on presence or not prostate cancer. The normal value may be as high as 4 or 5. It is worth noting that most patients with prostate cancer have elevated values of PSA. But, the opposite does not happen. So someone who has an elevated PSA value does not mean that he has cancer. For this reason you should consult an urologist to proceed with further testing. It is of great importance to note that men who have undergone surgery for benign prostatic hyperplasia often have the impression that he has had the entire prostate removed and therefore does not require regular screening for prostate cancer. This is not so, as the outside capsule of the prostate remains after surgery for benign prostatic hyperplasia, and may harbor cancer. Therefore, continued screening even in this case is called for.

It is very useful, when there is suspicion of prostate cancer, to perform rectal ultrasound. This examination provides useful information on the composition of the prostate. It can detect if there is any suspicious area and the doctor could obtain a sample by the use of needle and send for biopsy. A biopsy is the ultimate and only reliable method to answer the question of the presence of cancer. If the biopsy comes out positive then there is no doubt that cancer of the prostate is present. Moreover, the biopsy provides information regarding the so-called “stage of cancer” and how “bad” or not is the cancer. With this information, the treating urologist can propose appropriate solutions to our problem.

• Treatment

Prostate cancer can be addressed in different ways which include surveillance, radiotherapy, brachytherapy, hormonal therapy and surgery. The last method is the most effective and is called radical prostatectomy.

Surgical treatment is proposed in the initial stages of the disease. Radical prostatectomy is the surgical removal of the whole prostate gland and seminal vesicles. Then, the bladder is sutured to the urethra. Radical prostatectomy was performed for decades as an open surgical approach and included a large incision below the umbilicus. The laparoscopic approach avoids the incision and because of the sophisticated equipment used, achieves the lowest blood loss, less postoperative pain, faster recovery and mobilization of the patient. The catheter placed during surgery is removed the fifth day after surgery. However, the patient on the second day may leave the hospital to return after 3 days to remove the catheter.

• Complications

The main problems encountered after radical prostatectomy is difficulties in getting an erection and urinary incontinence. Complications are encountered after such a oncological surgery whose contribution in the fight for prostate cancer is invaluable. The main complication of radical prostatectomy is impotence. This is due to injury to the nerves responsible for sexual function. Impotence is almost always present immediately after radical prostatectomy and it may be unpleasant for the patient but erectile function recovers in a percentage of the patients within weeks or months. The development of surgical techniques and equipment has significantly reduced the percentage of impotence after such surgeries. Furthermore, when performing laparoscopic radical prostatectomy it is feasible to salvage as much as possible of the neural pathways that surround the prostate. This must always be balanced with the prospect of an optimal cancer survival outcome. Urinary incontinence after radical prostatectomy may be present due to damage to the mechanism that holds the urine in the bladder. This mechanism is provided by a valve or sphincter that ensures the so-called continence. The latter complication is frequent in the immediate post-operative period and continence is restored over a period of weeks.